Healthcare Provider Details

I. General information

NPI: 1083611883
Provider Name (Legal Business Name): MARTIN P KOLSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW SUITE 321
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

106 IRVING ST NW SUITE 321 SOUTH
WASHINGTON DC
20010-2927
US

V. Phone/Fax

Practice location:
  • Phone: 202-882-0200
  • Fax: 202-291-4130
Mailing address:
  • Phone: 202-882-0200
  • Fax: 202-291-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD5870
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDOO17838
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: